After multivariate adjustments, advanced age did not show any independent correlation with post-peripheral vascular intervention transfusion (OR 1.08, 95% CI 0.8 to 1.4, P=0.5) or contrast-induced nephropathy (OR 0.9, 95% CI 0.6 to 1.4, P=0.9), Benjamin R. Plaisance, MD, from the University of Michigan Hospitals and Health Center in Ann Arbor, and colleagues found.

Nor was advanced age correlated with major adverse cardiovascular events (OR 1.3, 95% CI: 0.7 to 2.3, P=0.4) or amputation (OR 0.7, 95% CI: 0.4 to 1.2, P=0.2), they wrote online in the Journal of the American College of Cardiology: Cardiovascular Interventions.

However, advanced age was found to be a predictor of vascular access complication (OR 2.2, 95% CI 1.2 to 3.9).

"These findings may support the notion of using PVI [peripheral vascular intervention] as a preferred revascularization strategy in the treatment of severe peripheral arterial disease in the elderly population," the authors concluded.

Plaisance and colleagues obtained their data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention (BMC2 PVI) registry, which includes only aorto-iliac, femoropopliteal, and below-the-knee interventions.

BMC2 PVI is designed to collect information on patients undergoing lower extremity peripheral vascular intervention in an effort to evaluate evidence-based disease management and to support collaborative improvement in quality of care and outcomes.

For the study, researchers included 7,769 patients who underwent procedures from 2001 through 2008. Patients were divided into three age categories: younger than 70 (n=4,017), between 70 and 80 (n=2,350), and 80 or older (n=1,402).

All intervention cases were performed at 18 hospital centers that participate in the registry, and their numbers ranged from five to 2,381 cases. Similar variations were observed in adverse outcomes across the consortium.

The elderly patients had more preexisting comorbidities including hypertension, congestive heart failure, and cerebrovascular disease/transient ischemic attack, as well as more frequent baseline anemia. They also were more likely to be women and presented with more severe peripheral arterial disease, including rest pain or the goal of limb salvage therapy.

Researchers defined "technical success" as vascular access, deployment of a device or devices, and <30% diameter residual stenosis after revascularization. They defined "procedural success" as technical success and freedom from major periprocedural complications.

Procedural success decreased as age increased: 81.4% in patients younger than 70, 78% for those between 70 and 80, and 74.2% for those 80 or older (P<0.0001).

The oldest patients had more complex below-knee revascularization procedures and more antegrade femoral access procedures. These two variables could be related to the lower success rate among the elderly, wrote Christopher J. White, MD, from the John Ochsner Heart and Vascular Institute in New Orleans, in an accompanying editorial.

Technical success also decreased with increasing age: 85% for those younger than 70 years, 82.1% for those between 70 and 80, and 78% for the octogenarians.

"According to uniform reporting standards in assessing endovascular treatments for chronic ischemia of lower limb arteries, technical and procedural success are considered two important parameters for successful outcomes in peripheral vascular interventions," the authors wrote.

Patients 80 and older were more likely to undergo balloon angioplasty (36.2% versus 31.7% and 27.1% for the other two age groups in descending order, P<0.0001) compared with stenting (33.6% versus 42.8% and 48.7%, P<0.0001).

They also were more likely to undergo atherectomy (16% versus 14.9% and 12.7% for the next two age groups in descending order (P=0.0003).

Plaisance and colleagues found that periprocedural complications were relatively low among all age groups.

And despite an unadjusted higher rate of major adverse cardiovascular events, contrast-induced nephropathy, and amputation in the octogenarians, inhospital death in all age groups was overall quite low, they wrote, and did not differ significantly.

They also found no difference in the incidence of myocardial infarction, the need for repeat intervention, or transient ischemic attack/stroke among the three groups.

In the editorial, White said the primary outcome of this "large, real-world sample of heterogeneous patients ... will inform the national lower extremity peripheral vascular intervention quality of care debate and impact future guideline documents."

The BMC2 PVI registry "is an excellent model for a 'win-win' strategy for all stakeholders involved in the care of patients with vascular disease," White wrote. "Kudos to the doctors, hospital administrators, and the leadership of Blue Cross Blue Shield of Michigan for figuring out how to collaboratively align their incentives in the best interests of their patients."

Study limitations include the observational nature of the data, and that the outcomes were not centrally adjudicated.

The work is supported by an unrestricted grant from Blue Cross Blue Shield of Michigan. Share, Gurm, and Grossman are supported by Blue Cross Blue Shield of Michigan. The latter two also receive support from the National Institutes of Health. Bove has received research support from Medtronic, Cook Medical, Gore Medical, Endologix, Cordis, and ev3. All other authors have reported that they have no relationships to disclose.

White has received research support from Boston Scientific and has served on the scientific advisory boards of St. Jude Medical, Baxter Healthcare, Cellular Therapy, and Neovasc.

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